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Publisher: Elsevier   (Total: 3042 journals)

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        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 3042 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 19, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 326, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 203, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 22, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 124, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 44, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 20, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 34, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 21, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 58)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 339, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 311, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 398, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 50, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 46, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 44, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 182, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 33, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 52, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 4)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 161, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 153, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover American Journal of Medicine
  [SJR: 2.023]   [H-I: 189]   [44 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
   Published by Elsevier Homepage  [3042 journals]
  • Subcutaneous Lesion in an Oncologic Patient
    • Authors: Ewelina Szczepanek-Parulska; Matylda Kludkowska; Lukasz Pielok; Jerzy Stefaniak; Marek Ruchala
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Ewelina Szczepanek-Parulska, Matylda Kludkowska, Lukasz Pielok, Jerzy Stefaniak, Marek Ruchala


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.03.019
       
  • Necrotizing Sarcoid Granulomatosis: Clinico-Radio-Pathologic Diagnosis
    • Authors: David John Tobias McArdle; John Patrick McArdle; Peter Jessup; Robin A. Harle; Serena Parker
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): David John Tobias McArdle, John Patrick McArdle, Peter Jessup, Robin A. Harle, Serena Parker


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.03.015
       
  • Hydrophilic Polymer Embolism: An Update for Physicians
    • Authors: Rashi I. Mehta; Rupal I. Mehta
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Rashi I. Mehta, Rupal I. Mehta


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.032
       
  • Humanizing the Electronic Medical Record with the Personal Fact
    • Authors: Irina A. Skylar-Scott; Barry J. Wu
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Irina A. Skylar-Scott, Barry J. Wu


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.027
       
  • The Complexities of Iron Deficiency in Patients After Bariatric Surgery
    • Authors: Amanda Velazquez; Caroline M. Apovian; Nawfal W. Istfan
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Amanda Velazquez, Caroline M. Apovian, Nawfal W. Istfan


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.040
       
  • Cough Syncope
    • Authors: Victor Waldmann; Nicolas Combes; Kumar Narayanan; Ardalan Sharifzadehgan; Abdeslam Bouzeman; Frankie Beganton; Stéphane Combes; Jean-Paul Albenque; Serge Boveda; Eloi Marijon
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Victor Waldmann, Nicolas Combes, Kumar Narayanan, Ardalan Sharifzadehgan, Abdeslam Bouzeman, Frankie Beganton, Stéphane Combes, Jean-Paul Albenque, Serge Boveda, Eloi Marijon


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.050
       
  • The Malnourished Heart: An Unusual Case of Heart Failure
    • Authors: Sebastian Bruera; Neeharika Reddy Kalakota; Ashok Balasubramanyam
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Sebastian Bruera, Neeharika Reddy Kalakota, Ashok Balasubramanyam


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.027
       
  • A Tale of Two Valves: An Echocardiographic Natural History of Radiation
           Heart Disease
    • Authors: Bo Xu; Wael Jaber; Serge Harb; Brian Griffin
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Bo Xu, Wael Jaber, Serge Harb, Brian Griffin


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.031
       
  • The Great Masquerader Strikes Again!
    • Authors: Abhishek Biswas; Sarah Lulu; Peruvemba S. Sriram
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Abhishek Biswas, Sarah Lulu, Peruvemba S. Sriram


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.035
       
  • Cytomegalovirus-Associated Hemophagocytic Syndrome in a 59-Year-Old Woman
           with Ulcerative Colitis
    • Authors: Chetan V. Vakkalagadda; Ramiro Cadena-Semanate; Lemuel R. Non
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Chetan V. Vakkalagadda, Ramiro Cadena-Semanate, Lemuel R. Non


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.018
       
  • An Acquired Factor X Inhibitor: The Importance of Understanding
           Coagulation
    • Authors: Isaac S. Chan; F. Joy Ogunsile
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Isaac S. Chan, F. Joy Ogunsile


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.046
       
  • Nosocomial Vertebral Osteomyelitis
    • Authors: Ami Schattner; Yosef Drahy
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Ami Schattner, Yosef Drahy


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.034
       
  • Sleep Duration and Impaired Glycemic Control
    • Authors: Tomoyuki Kawada
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Tomoyuki Kawada


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.042
       
  • Interpreting Phenotypic Features of Bicuspid Aortic Valve Disease: From
           Simplification to Complexity to Simplicity'
    • Authors: Evaldas Girdauskas; Peter N. Robinson; Yskert von Kodolitsch
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Evaldas Girdauskas, Peter N. Robinson, Yskert von Kodolitsch


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2016.12.043
       
  • Blood Pressure Goals in Functionally Limited Elderly Patients
    • Authors: Gulistan Bahat; Birkan İlhan; Asli Tufan; Mehmet Akif Karan
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Gulistan Bahat, Birkan İlhan, Asli Tufan, Mehmet Akif Karan


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2016.12.045
       
  • Will Physicians Stop Performing Physical Examinations'
    • Authors: Joseph S. Alpert
      Pages: 759 - 760
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Joseph S. Alpert


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.03.013
       
  • Urine Tests for Chronic Hypokalemia: When in Doubt, Check
           Urine-Sodium-to-Chloride Ratio
    • Authors: Yeong-Hau H. Lien
      Pages: 761 - 762
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Yeong-Hau H. Lien


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.040
       
  • Life with One Kidney: Primary Care and the Living Kidney Donor
    • Authors: David Serur; Todd Pesavento; Emilio Poglio; Rebecca Hays; Didier Mandelbrot
      Pages: 763 - 765
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): David Serur, Todd Pesavento, Emilio Poglio, Rebecca Hays, Didier Mandelbrot


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.017
       
  • Where Have the Generalists Gone' They Became Specialists, Then
           Subspecialists
    • Authors: James E. Dalen; Kenneth J. Ryan; Joseph S. Alpert
      Pages: 766 - 768
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): James E. Dalen, Kenneth J. Ryan, Joseph S. Alpert


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.026
       
  • How the USPSTF's Mammographic Screening Guidelines Should Be Interpreted
    • Authors: Vinay Prasad
      Pages: 769 - 770
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Vinay Prasad


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.021
       
  • False and Misleading Information About Lyme Disease
    • Authors: Eugene D. Shapiro; Phillip J. Baker; Gary P. Wormser
      Pages: 771 - 772
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Eugene D. Shapiro, Phillip J. Baker, Gary P. Wormser


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.030
       
  • Viewpoint: Stroke Prevention in Recent Guidelines for the Management of
           Patients with Atrial Fibrillation: An Appraisal
    • Authors: Tatjana S. Potpara; Gregory Y.H. Lip; Carina Blomström-Lundqvist; Chern-En Chiang; A. John Camm
      Pages: 773 - 779
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Tatjana S. Potpara, Gregory Y.H. Lip, Carina Blomström-Lundqvist, Chern-En Chiang, A. John Camm
      Formal guidelines play an important role in disseminating the best available evidence knowledge and are expected to provide simple and practical recommendations for the most optimal management of patients with various conditions. Such guidelines have important implications for many disease states, which thereby could be more professionally managed in everyday clinical practice by clinicians with divergent educational backgrounds, and also more easily implemented in wards or outpatient clinics, eliminating inequalities in health care management. In this brief Viewpoint we provide an appraisal on the recommendations pertinent to the prevention of atrial fibrillation–related stroke or systemic thromboembolism, as provided in recently published guidelines for the management of this arrhythmia.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.026
       
  • Associated Risk of Malignancy in Patients with Cardiovascular Disease:
           Evidence and Possible Mechanism
    • Authors: Tal Hasin; Zaza Iakobishvili; Giora Weisz
      Pages: 780 - 785
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Tal Hasin, Zaza Iakobishvili, Giora Weisz
      Cardiovascular disease and malignancy are leading causes of morbidity and mortality. Increased risk of malignancy was identified in patients with cardiovascular disease, including patients with heart failure, heart failure after myocardial infarction, patients undergoing cardiac intervention, and patients after a thrombotic event. Common risk factors and biological pathways can explain this association and are explored in this review. Further research is needed to establish the causes of malignancy in this population and direct possible intervention.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.024
       
  • Management of Anticoagulants and Antiplatelet Agents During Colonoscopy
    • Authors: Linda Anne Feagins
      Pages: 786 - 795
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Linda Anne Feagins
      Colonoscopy frequently is performed for patients who are taking aspirin, nonsteroidal anti-inflammatory drugs, antiplatelet agents, and other anticoagulants. These colonoscopies often involve polypectomy, which can be complicated by bleeding. The risks of precipitating thromboembolic complications if anticoagulants are stopped must be weighed against the risk of postpolypectomy bleeding if these agents are continued. This article systematically reviews the management of anticoagulation during elective and emergency colonoscopy. For patients undergoing colonoscopic polypectomy, the overall risk of postpolypectomy bleeding is <0.5%. Risk factors for postpolypectomy bleeding include large polyp size and anticoagulant use, especially warfarin and thienopyridines. For patients who do not stop aspirin or other nonsteroidal anti-inflammatory drugs prior to colonoscopy, the rate of postpolypectomy bleeding is not significantly different from that for patients who do not take those medications. For patients who continue thienopyridines and undergo polypectomy, the risk of delayed postpolypectomy bleeding is approximately 2.4%. Even for patients who interrupt warfarin, the risk of postpolypectomy bleeding is increased. The direct oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) have a rapid onset and offset of action, and periprocedural bridging generally is not necessary. For the thienopyridines, warfarin, and the direct oral anticoagulants, the decision to interrupt or continue these agents for endoscopy will involve considerable exercise of clinical judgment.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.052
       
  • Inner Peace: Cutaneous Polyarteritis Nodosa
    • Authors: Konstantinos Parperis; Fawad Rast
      Pages: 796 - 798
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Konstantinos Parperis, Fawad Rast


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.006
       
  • A Change of Pace: Sudden Hypotension
    • Authors: Neal Yuan; Rabih M. Geha; Nelson B. Schiller
      Pages: 799 - 801
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Neal Yuan, Rabih M. Geha, Nelson B. Schiller


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.03.026
       
  • In Deep: Cerebral Toxoplasmosis
    • Authors: Melanie R.F. Greenway; Keith A. Sacco; M. Caroline Burton
      Pages: 802 - 804
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Melanie R.F. Greenway, Keith A. Sacco, M. Caroline Burton


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.03.025
       
  • In Absentia: Lupus-Like Nephritis with Seronegative Antiphospholipid
           Syndrome
    • Authors: Ruaraidh F. Stewart; Christopher O.C. Bellamy; David C. Kluth; Neeraj Dhaun
      Pages: 805 - 808
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Ruaraidh F. Stewart, Christopher O.C. Bellamy, David C. Kluth, Neeraj Dhaun


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.015
       
  • Positive Airway Pressure Therapies and Hospitalization in Chronic
           Obstructive Pulmonary Disease
    • Authors: Monica M. Vasquez; Leslie A. McClure; Duane L. Sherrill; Sanjay R. Patel; Jerry Krishnan; Stefano Guerra; Sairam Parthasarathy
      Pages: 809 - 818
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Monica M. Vasquez, Leslie A. McClure, Duane L. Sherrill, Sanjay R. Patel, Jerry Krishnan, Stefano Guerra, Sairam Parthasarathy
      Background Hospitalization of patients with chronic obstructive pulmonary disease creates a huge healthcare burden. Positive airway pressure therapy is sometimes used in patients with chronic obstructive pulmonary disease, but the possible impact on hospitalization risk remains controversial. We studied the hospitalization risk of patients with chronic obstructive pulmonary disease before and after initiation of various positive airway pressure therapies in a “real-world” bioinformatics study. Methods We performed a retrospective analysis of administrative claims data of hospitalizations in patients with chronic obstructive pulmonary disease who received or did not receive positive airway pressure therapy: continuous positive airway pressure, bilevel positive airway pressure, and noninvasive positive pressure ventilation using a home ventilator. Results The majority of 1,881,652 patients with chronic obstructive pulmonary disease (92.5%) were not receiving any form of positive airway pressure therapy. Prescription of bilevel positive airway pressure (1.5%), continuous positive airway pressure (5.6%), and noninvasive positive pressure ventilation (<1%) in patients with chronic obstructive pulmonary disease demonstrated geographic-, sex-, and age-related variability. After adjusting for confounders and propensity score, noninvasive positive pressure ventilation (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.13-0.27), bilevel positive airway pressure (OR, 0.42; 95% CI, 0.39-0.45), and continuous positive airway pressure (OR, 0.70; 95% CI, 0.67-0.72) were individually associated with lower hospitalization risk in the 6 months post-treatment when compared with the 6 months pretreatment but not when compared with the baseline period between 12 and 6 months before treatment initiation. Stratified analysis suggests that comorbid sleep-disordered breathing, chronic respiratory failure, heart failure, and age less than 65 years were associated with greater benefits from positive airway pressure therapy. Conclusion Initiation of positive airway pressure therapy was associated with reduction in hospitalization among patients with chronic obstructive pulmonary disease, but the causality needs to be determined by randomized controlled trials.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2016.11.045
       
  • Digital Rectal Examination Reduces Hospital Admissions, Endoscopies, and
           Medical Therapy in Patients with Acute Gastrointestinal Bleeding
    • Authors: Manish P. Shrestha; Mark Borgstrom; Eugene Trowers
      Pages: 819 - 825
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Manish P. Shrestha, Mark Borgstrom, Eugene Trowers
      Background Although digital rectal examination is an established part of physical examinations in patients with acute gastrointestinal bleeding, clinicians are reluctant to perform a rectal examination. We intended to assess whether rectal examination affects the clinical management decision in these patients. Methods We performed a single-center, retrospective, cross-sectional study using data from electronic health records of patients aged ≥18 years presenting to the emergency department with acute gastrointestinal bleeding. Hospital admissions, intensive care unit admissions, gastroenterology consultation, initiation of medical therapy (proton pump inhibitor or octreotide), and inpatient endoscopy (upper endoscopy or colonoscopy) were assessed as outcomes. Univariate and multivariate logistic regression analyses were performed. Results Of 1237 patients with acute gastrointestinal bleeding, 549 (44.4%) did not have a rectal examination. Patients who had a rectal examination were less likely to be admitted than patients who did not have a rectal examination (adjusted odds ratio [AOR], 0.49; 95% confidence interval [CI], 0.30-0.79; P = .004). Patients who had a rectal examination were less likely to be started on medical therapy (AOR, 0.64; 95% CI, 0.41-0.98; P = .04) and to have endoscopy (AOR, 0.64; 95% CI, 0.44-0.94; P = .02) than patients who did not have a rectal examination. Conclusions Rectal examination in patients with acute gastrointestinal bleeding can assist clinicians with clinical management decision and reduce admissions, endoscopies, and medical therapy in these patients.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.036
       
  • The Effect of Combined Aspirin and Clopidogrel Treatment on Cancer
           Incidence
    • Authors: Avi Leader; Ravit Zelikson-Saporta; David Pereg; Galia Spectre; Uri Rozovski; Pia Raanani; Doron Hermoni; Michael Lishner
      Pages: 826 - 832
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Avi Leader, Ravit Zelikson-Saporta, David Pereg, Galia Spectre, Uri Rozovski, Pia Raanani, Doron Hermoni, Michael Lishner
      Background Multiple studies have shown an association between aspirin treatment and a reduction in newly diagnosed cancer. Conversely, there are conflicting clinical and laboratory data on the effect of combined clopidogrel and aspirin therapy on cancer incidence, including analyses suggesting an increased cancer risk. No large-scale cohort study has been performed to address this issue in a heterogeneous real-world scenario. We investigated the effect of clopidogrel and aspirin on cancer incidence compared with aspirin alone and no antiplatelet therapy. Methods A population-based historical cohort study of subjects aged ≥50 years covered by Clalit Health Services, an Israeli health maintenance organization, was performed. Patients treated with the newer antiplatelet drugs, prasugrel or ticagrelor, which, like clopidogrel, inhibit adenosine diphosphate receptors, and those with prior cancer were excluded. Prescription records of antiplatelet medication were retrieved. Results The cohort included 183,912 subjects diagnosed with 21,974 cancer cases based upon the International Classification of Diseases, Ninth Revision. Dual aspirin and clopidogrel was prescribed in 9.6%, while 49% received aspirin alone and 41% used neither. Compared with nonusers, there was a lower risk of cancer in subjects exposed to aspirin with (hazard ratio [HR] 0.46; 95% confidence interval [CI], 0.44-0.49) or without clopidogrel (HR 0.54; 95% CI, 0.52-0.56), on long-term follow-up. Combined treatment was associated with a lower cancer risk than the aspirin-only group (HR 0.92; 95% CI, 0.86-0.97). Conclusions Dual clopidogrel and aspirin treatment is safe regarding the cancer risk. This study generates the hypothesis that clopidogrel may reduce cancer incidence.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.022
       
  • GLP-1 Levels Predict Mortality in Patients with Critical Illness as Well
           as End-Stage Renal Disease
    • Authors: Corinna Lebherz; Georg Schlieper; Julia Möllmann; Florian Kahles; Marvin Schwarz; Jan Brünsing; Nada Dimkovic; Alexander Koch; Christian Trautwein; Jürgen Flöge; Nikolaus Marx; Frank Tacke; Michael Lehrke
      Pages: 833 - 841.e3
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Corinna Lebherz, Georg Schlieper, Julia Möllmann, Florian Kahles, Marvin Schwarz, Jan Brünsing, Nada Dimkovic, Alexander Koch, Christian Trautwein, Jürgen Flöge, Nikolaus Marx, Frank Tacke, Michael Lehrke
      Background Glucagon-like peptide 1 (GLP-1) is an incretin hormone, which stimulates glucose-dependent insulin secretion from the pancreas and holds immune-regulatory properties. A marked increase of GLP-1 has been found in critically ill patients. This study was performed to elucidate the underlying mechanism and evaluate its prognostic value. Methods GLP-1 plasma levels were determined in 3 different patient cohorts: 1) critically ill patients admitted to our intensive care unit (n = 215); 2) patients with chronic kidney disease on hemodialysis (n = 173); and 3) a control group (no kidney disease, no acute inflammation, n = 105). In vitro experiments were performed to evaluate GLP-1 secretion in response to human serum samples from the above-described cohorts. Results Critically ill patients presented with 6.35-fold higher GLP-1 plasma level in comparison with the control group. There was a significant correlation of GLP-1 levels with markers for the severity of inflammation, but also kidney function. Patients with end-stage renal disease displayed 4.46-fold higher GLP-1 concentrations in comparison with the control group. In vitro experiments revealed a strong GLP-1-inducing potential of serum from critically ill patients, while serum from hemodialysis patients only modestly increased GLP-1 secretion. GLP-1 levels independently predicted mortality in critically ill patients and patients with end-stage renal disease. Conclusions Chronic and acute inflammatory processes like sepsis or chronic kidney disease increase circulating GLP-1 levels. This most likely reflects a sum effect of increased GLP-1 secretion and decreased GLP-1 clearance. GLP-1 plasma levels independently predict the outcome of critically ill and end-stage renal disease patients.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.03.010
       
  • Identification of the Causes for Chronic Hypokalemia: Importance of
           Urinary Sodium and Chloride Excretion
    • Authors: Kun-Lin Wu; Chih-Jen Cheng; Chih-Chen Sung; Ming-Hua Tseng; Yu-Juei Hsu; Sung-Sen Yang; Tom Chau; Shih-Hua Lin
      Pages: 846 - 855
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Kun-Lin Wu, Chih-Jen Cheng, Chih-Chen Sung, Ming-Hua Tseng, Yu-Juei Hsu, Sung-Sen Yang, Tom Chau, Shih-Hua Lin
      Background Uncovering the correct diagnosis of chronic hypokalemia with potassium (K+) wasting from the kidneys or gut can be fraught with challenges. We identified clinical and laboratory parameters helpful for differentiating the causes of chronic hypokalemia. Methods Normotensive patients referred to our tertiary academic medical center for the evaluation of chronic hypokalemia were prospectively enrolled over 5 years. Clinical features, laboratory examinations—including blood and spot urine electrolytes, acid-base status, biochemistries, and hormones—as well as genetic analysis, were determined. Results Ninety-nine patients with chronic normotensive hypokalemia (serum K+ 2.8 ± 0.4 mmol/L, duration 4.1 ± 0.9 years) were enrolled. Neuromuscular symptoms were the most common complaints. Although Gitelman syndrome (n = 33), Bartter syndrome (n = 10), and distal renal tubular acidosis (n = 12) were the predominant renal tubular disorders, 44 patients (44%) were diagnosed with anorexia/bulimia nervosa (n = 21), surreptitious use of laxatives (n = 11), or diuretics (n = 12). Patients with gastrointestinal causes and surreptitious diuretics use exhibited a female predominance, lower body mass index, and less K+ supplementation. High urine K+ excretion (transtubular potassium gradient >3, urine K+/Cr >2 mmol/mmol) was universally present in patients with renal tubular disorders, but also found in >50% patients with gastrointestinal causes. Of interest, while urine sodium (Na+) and chloride (Cl−) excretions were high and coupled (urine Na+/Cl− ratio ∼1) in renal tubular disorders and “on” diuretics use, skewed or uncoupled urine Na+ and Cl− excretions were found in anorexia/bulimia nervosa and laxatives abuse (urine Na+/Cl− ratio: 5.0 ± 2.2, 0.4 ± 0.2, respectively) and low urine Na+ and Cl− excretions with fixed Na+/Cl− ratios (0.9 ± 0.2) when “off” diuretics. Conclusion Besides body mass index, sex, and blood acid-base status, integrated interpretation of the urine Na+:Cl− excretion and their ratio is important to make an accurate diagnosis and treatment plan for patients with chronic normotensive hypokalemia.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.023
       
  • Splenectomy as a Destination: Improving Quality of Care Among Asplenic
           Veterans Through a Travel Clinic
    • Authors: Aaron P. Mitchell; Joel C. Boggan; Karen Lau; David L. Simel
      Pages: 856 - 861
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Aaron P. Mitchell, Joel C. Boggan, Karen Lau, David L. Simel
      Background Asplenic patients are at risk for severe infections, but adherence to recommended preventive education and vaccination is poor. The goal of this study was to demonstrate that a targeted intervention can improve vaccination rates in a population of asplenic veterans. Methods Surgically asplenic patients actively receiving care in our health care system were identified via a database search. Patients were contacted via mailed letters and encouraged to attend an existing travel clinic with a new process designed for asplenic patients. In the clinic, patients were educated on the risks of asplenia and proper preventive precautions, a vaccination history was taken, and patients were administered any additional indicated vaccines. Results The database search yielded 113 patients; an additional 14 asplenic patients were identified and referred to the clinic by providers, and 2 were referred prior to planned splenectomy. Among all asplenic patients, the first-year referral rate to clinic was 38/129 (29%). During the first year of the intervention, there were increases in the rates of 3 of 4 recommended vaccinations: pneumococcal conjugate, 19% to 55% (P <.001); Haemophilus influenzae type B, 19% to 35% (P = .007); and meningococcal vaccine, 24% to 43% (P = .002). The pneumococcal polysaccharide vaccination rate increased from 91% to 93% (P = .62). Conclusions Targeted interventions can improve guideline-based care for asplenic patients. The creation of a clinic designed for asplenic patients led to increases in 3 of 4 recommended vaccinations. This strategy may be applicable to other health care systems with similar numbers of asplenic patients.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.024
       
  • Evaluation of Deprescribing Amiodarone After New-Onset Atrial Fibrillation
           in Critical Illness
    • Authors: Areerut Leelathanalerk; Wannisa Dongtai; Yvonne Huckleberry; Brian Kopp; John Bloom; Joseph Alpert
      Pages: 864 - 866
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Areerut Leelathanalerk, Wannisa Dongtai, Yvonne Huckleberry, Brian Kopp, John Bloom, Joseph Alpert
      Background Recent studies have shed light on the continued prescription of inpatient medications upon hospital discharge, despite the original intent of short-term inpatient therapy. Amiodarone, an antiarrhythmic associated with significant adverse effects with long-term use, is commonly used for new-onset atrial fibrillation in critical illness (NAFCI). Although it is often preferred in this setting of hemodynamic instability, a prescription for long-term use should be carefully considered, preferably by a cardiologist. This study was conducted to evaluate the incidence of patients discharged on amiodarone without a cardiology consult or referral after being initiated on amiodarone for NAFCI. Methods We conducted a retrospective review of all patients newly prescribed amiodarone for NAFCI over a 2-year period. The primary outcome was the percentage of patients who were continued on amiodarone upon hospital discharge without review by or outpatient referral to a cardiologist. Results Of the 100 patients who met inclusion criteria, 59 patients were prescribed amiodarone upon hospital discharge. Of these, 48 patients (81.4%) had converted to normal sinus rhythm with the resolution of critical illness. Of 100 patients, 23 received prescriptions for amiodarone upon discharge without a cardiology consult or referral. Conclusion Amiodarone was frequently continued upon discharge without referral to a cardiologist in patients initiated on this therapy for NAFCI. This may contribute to unnecessary long-term therapy, thereby increasing the risk for significant side effects, drug interactions, and increased healthcare costs. This study suggests that careful medication reconciliation through all transitions of care, including discharge, is essential.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.02.025
       
  • The Intention-to-Treat Analysis Is Not Always the Conservative Approach
    • Authors: Ian Shrier; Evert Verhagen; Steven D. Stovitz
      Pages: 867 - 871
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Ian Shrier, Evert Verhagen, Steven D. Stovitz


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.03.023
       
  • Corrigendum to ‘Treatment of Right Heart Thrombi Associated with Acute
           Pulmonary Embolism’ American Journal of Medicine 130(2017): 588-595
    • Authors: Deisy Barrios; Jeremy Chavant; David Jiménez; Laurent Bertoletti; Vladimir Rosa-Salazar; Alfonso Muriel; Alain Viallon; Carmen Fernández-Capitán; Roger D. Yusen; Manuel Monreal
      First page: 874
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Deisy Barrios, Jeremy Chavant, David Jiménez, Laurent Bertoletti, Vladimir Rosa-Salazar, Alfonso Muriel, Alain Viallon, Carmen Fernández-Capitán, Roger D. Yusen, Manuel Monreal


      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.04.011
       
  • Western Osteoporosis Alliance Clinical Practice Series: Evaluating the
           Balance of Benefits and Risks of Long-Term Osteoporosis Therapies
    • Authors: David A. Hanley; Michael R. McClung; K. Shawn Davison; Larry Dian; Steve T. Harris; Paul D. Miller; E. Michael Lewiecki; David L. Kendler
      Pages: 862.e1 - 862.e7
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): David A. Hanley, Michael R. McClung, K. Shawn Davison, Larry Dian, Steve T. Harris, Paul D. Miller, E. Michael Lewiecki, David L. Kendler
      Osteoporosis is a chronic disease that requires life-long strategies to reduce fracture risk. Few trials have investigated the balance of benefits and risk with long-term use of osteoporosis therapies, and fewer still have investigated the consequences of treatment discontinuation. The best available evidence suggests that up to 10 years of treatment with an oral bisphosphonate maintains the degree of fracture risk reduction observed in the 3-year registration trials. With denosumab, 10 years of therapy appears to provide fracture risk reduction similar to or better than that observed in the 3-year registration trial. Available data suggest an increasing but low risk of fractures with atypical features with increasing duration of bisphosphonate therapy. Published data linking duration of therapy to osteonecrosis of the jaw are lacking for bisphosphonates and denosumab. Other side effects associated with denosumab or bisphosphonates do not appear to be related to therapy duration. The antifracture benefits of long-term therapy with bisphosphonates and denosumab in appropriately selected patients outweigh the low risk of serious side effects.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.03.002
       
  • Incidence, Frequency, and Clinical Characteristics of Type 3 Myocardial
           Infarction in Clinical Practice
    • Authors: Nikolaj Jangaard; Laura Sarkisian; Lotte Saaby; Søren Mikkelsen; Anne Marie Lassen; Niels Marcussen; Jørgen L. Thomsen; Axel C.P. Diederichsen; Kristian Thygesen; Hans Mickley
      Pages: 862.e9 - 862.e14
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Nikolaj Jangaard, Laura Sarkisian, Lotte Saaby, Søren Mikkelsen, Anne Marie Lassen, Niels Marcussen, Jørgen L. Thomsen, Axel C.P. Diederichsen, Kristian Thygesen, Hans Mickley
      Objectives Cardiac death in a patient with symptoms and electrocardiographic changes indicative of myocardial ischemia but without available measurements of cardiac biomarkers is designated a type 3 myocardial infarction. We wanted to investigate the incidence, the frequency, and the characteristics of patients diagnosed as type 3 myocardial infarction. Methods The occurrence of deaths in a well-defined geographic region was retrieved from the Danish Civil Registration System during a 1-year period from 2010 to 2011. Complementary data concerning causes of deaths were obtained from the Danish Register of Causes of Death, and ambulance and hospital patient files. Adjudication of the diagnosis was done by 2 local experts and one external senior cardiologist. Results A total of 2766 of the 246,723 adult residents in the region had died. A type 3 myocardial infarction was diagnosed in 18 individuals, corresponding to an annual incidence of 7.3/100,000 person-years. During the same 1-year period, 488 patients had other types of myocardial infarction implying a 3.6% frequency of type 3 myocardial infarction (18 of 506) among all myocardial infarctions. Conclusion Type 3 myocardial infarction is a rare observation in clinical practice with an annual incidence below 10/100,000 person-years and a frequency of 3%-4% among all types of myocardial infarction. If autopsy data are included, the number of type 3 myocardial infarctions will increase.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2016.12.034
       
  • How Well Are Pulses Measured' Practice-Based Evidence from an
           Observational Study of Acutely Ill Medical Patients During Hospital
           Admission
    • Authors: Martin Otyek Opio; John Kellett
      Pages: 863.e13 - 863.e16
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Martin Otyek Opio, John Kellett
      Background Although taking a radial pulse is considered to be an essential clinical skill, there have been few reports on how well it is measured in clinical practice, and how its accuracy and precision are influenced by rate, rhythm, and blood pressure. Methods This study is a retrospective quality audit carried out as part of a larger ongoing prospective observational trial. The radial pulse rates recorded by 2 research nurses were compared with the electrocardiogram (ECG) heart rates measured on acutely ill medical patients during their admission to a resource-poor hospital in sub-Saharan Africa. Results There were 619 ECGs performed on 231 patients while they were in the hospital. The median interval between measuring the vital signs and obtaining an ECG was 12.6 minutes (mean 62.3, SD 104.3 minutes). The correlation coefficient between the pulse rate recorded and ECG heart rate was 0.54. The bias between the pulse rate and the ECG heart rate was 1.34, SD 13.51 beats per minute (ie, limits of agreement 26.5 beats per minute). Bias and variance were not influenced by blood and pulse pressure. However, tachycardia increased the variance and was the only independent predictor of a pulse deficit (odds ratio 2.32; 95% confidence interval, 1.53-3.51; chi-squared 17.21; P < .0001). Conclusion Practice-based evidence shows that in acutely ill patients, there is a poor correlation between the radial pulse and the ECG heart rate, and that tachycardia increases the variance and is the only independent predictor of a pulse deficit.

      PubDate: 2017-06-16T22:55:59Z
      DOI: 10.1016/j.amjmed.2017.01.033
       
  • Subscription Information
    • Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7


      PubDate: 2017-06-16T22:55:59Z
       
  • The Reply
    • Authors: Donald Bliwise; Sophia Greer
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Donald L. Bliwise, Sophia A. Greer


      PubDate: 2017-06-16T22:55:59Z
       
  • The Reply
    • Authors: Luca Longobardo; Renuka Jain Scipione Carerj Concetta Zito Bijoy Khandheria
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Luca Longobardo, Renuka Jain, Scipione Carerj, Concetta Zito, Bijoy K. Khandheria


      PubDate: 2017-06-16T22:55:59Z
       
  • The Reply
    • Authors: Chirag Bavishi; Sangita Goel Franz Messerli
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Chirag Bavishi, Sangita Goel, Franz H. Messerli


      PubDate: 2017-06-16T22:55:59Z
       
  • Off the Charts
    • Authors: Suzanne Koven
      Abstract: Publication date: July 2017
      Source:The American Journal of Medicine, Volume 130, Issue 7
      Author(s): Suzanne Koven


      PubDate: 2017-06-16T22:55:59Z
       
 
 
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